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Mogu li lekovi da smanje tiroidne noduse?
Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd

e-adresazandjelkovic18@gmail.com
Ključne reči: tiroidni nodusi; supresivna terapija tiroksinom
Sažetak
Iako su povoljni efekti primene ekstrakta štitaste žlezde u lečenju struma uočeni još pre više od jednog veka, opravdanost TSH supresivne terapije kod benignih nodoznih struma još uvek je predmet rasprava u stručnoj literaturi. Nedostatak dokaza o univerzalno povoljnoj terapijskoj efikasnosti ostavlja mogućnost primene L-tiroksina samo kod pojedinačnih slučajeva. Ovakvom stavu doprinose činjenice da su u dosadašnjim studijama uključivani bolesnici sa difuznim, difuzno-nodoznim i polinodoznim strumama iz područja sa različitim unosom joda. Ostvarena regresija veličine, definisana kao povoljan ishod, kretala se u rasponu do ~50%, s tim što su bolji rezultati ostvarivani kod difuzno polinodoznih struma. S druge strane, izveštaji iz nekoliko randomizovanih kontrolisanih studija ukazuju da kratkoročna primena L-tiroksina kod solitarnih netoksičnih nodoznih struma nema prednosti u odnosu na placebo. Primena kalijum-jodida jednako je efikasna kao i supresija L-tiroksinom ali je praktično napuštena zbog neželjenih sporednih efekata. Ukoliko je lečenje L-tiroksinom izbor, lek treba dati u dozi da suprimira TSH na nivo od 0,1 do 0,3 mU/L. Lečenje treba sprovoditi 6 do 12 meseci. Dužetrajnija terapija rezervisana je samo za slučajeve sa ehotomografski potvrđenom redukcijom veličine nodusa. Imati u vidu mogućnost osteoporoze kod postmenopauzalnih žena i kardijalnih komplikacija kod starijih. Perkutana aplikacija etanola u benigne afunkcionalne solitarne noduse, kao i terapija radiojodom uz prethodno davanje rekombinantnog humanog TSH kod benignih netoksičnih polinodoznih struma jesu načini lečenja koji obećavaju ali zahtevaju čvršće dokaze za širu terapijsku primenu.
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O članku

jezik rada: srpski
vrsta rada: neklasifikovan
DOI: 10.5937/medgla1557007A
objavljen u SCIndeksu: 25.06.2015.

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